Pulmonary-artery pressure and exhaled nitric oxide in Bolivian and Caucasian high altitude dwellers.

There is evidence that high altitude populations may be better protected from hypoxic pulmonary hypertension than low altitude natives, but the underlying mechanism is incompletely understood. In Tibetans, increased pulmonary respiratory NO synthesis attenuates hypoxic pulmonary hypertension. It has been speculated that this mechanism may represent a generalized high altitude adaptation pattern, but direct evidence for this speculation is lacking. We therefore measured systolic pulmonary-artery pressure (Doppler chocardiography) and exhaled nitric oxide (NO) in 34 healthy, middle-aged Bolivian high altitude natives and in 34 age- and sex-matched, well-acclimatized Caucasian low altitude natives living at high altitude (3600 m). The mean+/-SD systolic right ventricular to right atrial pressure gradient (24.3+/-5.9 vs. 24.7+/-4.9 mmHg) and exhaled NO (19.2+/-7.2 vs. 22.5+/-9.5 ppb) were similar in Bolivians and Caucasians. There was no relationship between pulmonary-artery pressure and respiratory NO in the two groups. These findings provide no evidence that Bolivian high altitude natives are better protected from hypoxic pulmonary hypertension than Caucasian low altitude natives and suggest that attenuation of pulmonary hypertension by increased respiratory NO synthesis may not represent a universal adaptation pattern in highaltitude populations.

Effect of added dead space on sleep disordered breathing at high altitude.

OBJECTIVE: Sleep disordered breathing with central apnea or hypopnea frequently occurs at high altitude and is thought to be caused by a decrease in blood CO(2) level. The aim of this study was to assess the effects of added respiratory dead space on sleep disordered breathing.¦METHODS: Full polysomnographies were performed on 12 unacclimatized swiss mountaineers (11 males, 1 female, mean age 39±12 y.o.) in Leh, Ladakh (3500m). In random order, half of the night was spent with a 500ml increase in dead space through a custom designed full face mask and the other half without it.¦RESULTS: Baseline data revealed two clearly distinct groups: one with severe sleep disordered breathing (n=5, AHI>30) and the other with moderate to no disordered breathing (n=7, AHI<30). DS markedly improved breathing in the first group (baseline vs DS): apnea hypopnea index (AHI) 70.3±25.8 vs 29.4±6.9 (p=0.013), oxygen desaturation index (ODI): 72.9±24.1/h vs 42.5±14.4 (p=0.031), whereas it had no significant effect in the second group or in the total population. Respiratory events were almost exclusively central apnea or hypopnea. Microarousal index, sleep efficiency, and sleep architecture remained unchanged with DS. A minor increase in mean PtcCO(2) (n=3) was observed with DS.¦CONCLUSION: A 500ml increase in dead space through a fitted mask may improve nocturnal breathing in mountaineers with severe altitude-induced sleep disordered breathing.

Matéria orgânica em Neossolo de altitude: influência do manejo da pastagem na sua composição e teor

A queima da pastagem após o inverno é uma prática antiga em solos de altitude, que visa principalmente ao rebrote da vegetação. Entretanto, o impacto do manejo da pastagem na matéria orgânica do solo de Neossolo de altitude ainda é pouco conhecido. O presente trabalho propôs-se a investigar a composição e o teor de matéria orgânica em perfis de Neossolo da região de São José dos Ausentes, RS, e relacionar os resultados com a ocorrência de queimadas e com o pastejo, empregando como comparação solo sob mata nativa. Os ambientes estudados foram: campo nativo pastejado (2 animais ha-1) sem queima há 22 anos, campo nativo pastejado sujeito à queima bienal (0,5 animal ha-1) e mata nativa adjacente à área de pastagem. Foram coletadas amostras compostas nas camadas de 0-5, 5-10, 10-15 e 15-30 cm, sendo determinados os teores de óxidos de Fe (Fe d e Fe o), de C e de N e realizadas análises de espectroscopia de infravermelho e de termogravimetria. O ambiente alterado periodicamente pelo fogo apresentou maior teor de matéria orgânica em camadas subsuperficiais e, em geral, maior proporção de estruturas quimicamente mais lábeis, comparativamente à pastagem sem queima. Nesse ambiente, o menor teor de C foi atribuído ao pastejo mais intensivo do que o da pastagem alterada pelo fogo. A distribuição de C no ambiente de mata nativa assemelhou-se à de pastagem sem queima. No entanto, na mata a proporção de matéria orgânica de baixo peso molecular extraível com solução de HCl 0,1 mol L-1, relacionada principalmente à atividade microbiana, superou aquela encontrada sob pastagem nativa.

New insights in the pathogenesis of high-altitude pulmonary edema.

High-altitude pulmonary edema is a life-threatening condition occurring in predisposed but otherwise healthy individuals. It therefore permits the study of underlying mechanisms of pulmonary edema in the absence of confounding factors such as coexisting cardiovascular or pulmonary disease, and/or drug therapy. There is evidence that some degree of asymptomatic alveolar fluid accumulation may represent a normal phenomenon in healthy humans shortly after arrival at high altitude. Two fundamental mechanisms then determine whether this fluid accumulation is cleared or whether it progresses to HAPE: the quantity of liquid escaping from the pulmonary vasculature and the rate of its clearance by the alveolar respiratory epithelium. The former is directly related to the degree of hypoxia-induced pulmonary hypertension, whereas the latter is determined by the alveolar epithelial sodium transport. Here, we will review evidence that, in HAPE-prone subjects, impaired pulmonary endothelial and epithelial NO synthesis and/or bioavailability may represent a central underlying defect predisposing to exaggerated hypoxic pulmonary vasoconstriction and, in turn, capillary stress failure and alveolar fluid flooding. We will then demonstrate that exaggerated pulmonary hypertension, although possibly a conditio sine qua non, may not always be sufficient to induce HAPE and how defective alveolar fluid clearance may represent a second important pathogenic mechanism.

Respiratory nitric oxide and pulmonary artery pressure in children of aymara and European ancestry at high altitude.

Invasive studies suggest that healthy children living at high altitude display pulmonary hypertension, but the data to support this assumption are sparse. Nitric oxide (NO) synthesized by the respiratory epithelium regulates pulmonary artery pressure, and its synthesis was reported to be increased in Aymara high-altitude dwellers. We hypothesized that pulmonary artery pressure will be lower in Aymara children than in children of European ancestry at high altitude, and that this will be related to increased respiratory NO. We therefore compared pulmonary artery pressure and exhaled NO (a marker of respiratory epithelial NO synthesis) between large groups of healthy children of Aymara (n = 200; mean +/- SD age, 9.5 +/- 3.6 years) and European ancestry (n = 77) living at high altitude (3,600 to 4,000 m). We also studied a group of European children (n = 29) living at low altitude. The systolic right ventricular to right atrial pressure gradient in the Aymara children was normal, even though significantly higher than the gradient measured in European children at low altitude (22.5 +/- 6.1 mm Hg vs 17.7 +/- 3.1 mm Hg, p < 0.001). In children of European ancestry studied at high altitude, the pressure gradient was 33% higher than in the Aymara children (30.0 +/- 5.3 mm Hg vs 22.5 +/- 6.1 mm Hg, p < 0.0001). In contrast to what was expected, exhaled NO tended to be lower in Aymara children than in European children living at the same altitude (12.4 +/- 8.8 parts per billion [ppb] vs 16.1 +/- 11.1 ppb, p = 0.06) and was not related to pulmonary artery pressure in either group. Aymara children are protected from hypoxic pulmonary hypertension at high altitude. This protection does not appear to be related to increased respiratory NO synthesis.

Atributos físicos relacionados à compactação de solos sob vegetação nativa em região de altitude no Sul do Brasil

A compactação causada por atividades antrópicas altera os atributos físicos do solo, causando redução na produtividade e impactos ao ambiente. Muitos estudos sobre esse tema têm sido realizados em solos agrícolas, porém poucas são as informações em áreas com vegetação nativa, nas quais, geralmente, os teores de matéria orgânica são mais elevados. Assim, é oportuno avaliar a relação entre os atributos físicos relacionados à compactação, nessas condições, a fim de estabelecer valores de referência para projetos de recuperação de áreas degradadas em campos naturais ou matas ciliares. Objetivou-se relacionar densidade máxima (DsMáx), umidade ótima de compactação (UOC) e densidade relativa (DR) com os limites de consistência, granulometria e teor de matéria orgânica de solos predominantes do Planalto Sul do Estado de Santa Catarina sob vegetação nativa de clima temperado. Amostras do horizonte A foram coletadas em dois Nitossolos, dois Neossolos e dois Cambissolos. Foram avaliados: a granulometria, a densidade de partícula, o teor de carbono orgânico total, os limites de liquidez, de plasticidade e de pegajosidade, o índice de plasticidade, a densidade máxima, a umidade ótima de compactação, a densidade do solo e a densidade relativa. A DsMáx aumenta com o teor de areia total e areia fina e reduz com os teores de argila e com os limites de liquidez e de pegajosidade. A UOC diminui nos solos arenosos, especialmente naqueles com predominância de areia fina, e aumenta nos argilosos ou com maior teor de carbono orgânico total e dos limites de Atterberg. A UOC variou entre 0,76 e 1,05 vezes o limite de plasticidade, tendo relação direta com o teor de silte, indicando que a umidade ótima de compactação não pode ser avaliada apenas com a determinação do limite de plasticidade de um solo. Os solos de altitude do Planalto Sul de SC têm relação UOC/LP diferente da de solos de outros locais, como consequência dos elevados teores de matéria orgânica desses solos.

Humic Haplustox under different land uses in a high altitude environment in the Agreste region of Pernambuco, Brazil

The Garanhuns Plateau in the Agreste region of the State of Pernambuco, Brazil is characterized by humid climatic conditions due to orographic rains, unlike the surrounding semiarid region. These soils are subjected to intense agricultural use and are extremely important for the regional economy. This study was carried out in the municipality of Brejão in the Agreste region with the aim of assessing changes in humic Haplustox soils subjected to different land uses. Four plots with different vegetation covers (native forest, secondary shrubby vegetation (capoeira), traditional cropping system, and planted pasture) were selected, and samples were taken from a soil profile and four small pits surrounding it at each site. Physical and chemical properties were assessed, including aggregate stability, humic organic fractions, and a microbiological evaluation through determination of basal respiration, microbial biomass carbon, and metabolic quotient. The soils under study showed physical and chemical properties typical of a Haplustox, such as low nutrient content, low cation exchange capacity, and high levels of acidity and Al saturation. The total organic carbon (TOC) contents were high regardless of the type of land use. Aggregates < 2 mm were dominant in all the conditions under study. The TOC content was higher in the soil under capoeira, 43.91 g kg-1 on the surface, while 34.36 and 33.43 g kg-1 of TOC were observed in the first layer of forest and pasture soils, respectively. While the microbial biomass C (MBC) was greater than 700 mg kg-1 in the forest and pasture areas (in the 0-5 cm layer), and 588 mg kg-1 in the soil under capoeira, these numbers were not statistically different. In the cultivated soil area, there was a reduction of around 28 % in TOC and MBC contents. Agricultural activity contributed to degradation of the humic horizon, as can be seen from a significant decrease in the TOC and changes in the relative distribution of the humic fractions. In contrast, aggregate stability was not altered as a function of the different land uses; the soil under planted pasture and capoeira were similar to the soil under native forest. Humin was the most important humified fraction for C reserves, contributing over 40 % of the TOC in these soils.

Pulmonary-artery pressure and exhaled nitric oxide in bolivian and caucasian high altitude dwellers

Rapport de synthèse : Plusieurs études suggèrent que les populations vivant en haute altitude sont mieux protégées contre l'hypertension pulmonaire hypoxique que celles originaires de la plaine. Cependant, les mécanismes sous jacents ne sont pas bien compris. Chez les Tibétains, la synthèse augmentée par le système respiratoire de monoxyde d'azote (NO) atténue l'hypertension pulmonaire hypoxique. Il a été spéculé que ce mécanisme pourrait représenter un mode généralisé d'adaptation à la haute altitude, mais il n'existe pas de preuve directe qui consume cette hypothèse. Nous avons donc mesuré la pression artérielle pulmonaire (par échocardiographie Doppler) ainsi que la concentration du NO dans l'air exhalé chez 34 Boliviens en bonne santé, nés et ayant toujours vécus en haute altitude (3600 m) et chez 34 Caucasiens apparentés pour l'âge et le sexe, nés en basse altitude mais vivant depuis de nombreuses années à cette même haute altitude (3600 mètres). La pression artérielle pulmonaire (24.3±5.9 vs. 24.7±4.9 mm Hg) et le NO exhalé (19.2±7.2 vs. 22.5±9.5 ppb) étaient similaires chez les Boliviens et les Caucasiens. Il n'y avait aucune corrélation entre la pression artérielle pulmonaire et le NO respiratoire dans les deux groupes. Ces résultats ne fournissent donc aucune évidence que les Boliviens nés en haute altitude sont mieux protégés contre l'hypertension pulmonaire hypoxique que les Caucasiens nés à basse altitude. Cela suggère que l'atténuation de l'hypertension pulmonaire par une synthèse accrue de NO respiratoire ne représente pas un mode universel d'adaptation des populations à la haute altitude. Abstract : There is evidence that high altitude populations may be better protected from hypoxic pulmonary hypertension than low altitude natives, but the underlying mechanism is incompletely understood. In Tibetans, increased pulmonary respiratory NO synthesis attenuates hypoxic pulmonary hypertension. It has been speculated that this mechanism may represent a generalized high altitude adaptation pattern, but direct evidence for this speculation is lacking. We therefore measured systolic pulmonary-artery pressure (Doppler echocardiography) and exhaled nitric oxide (NO) in 34 healthy, middle-aged Bolivian high altitude natives and in 34 age- and sex-matched, well-acclimatized Caucasian low altitude natives living at high altitude (3600 m). The mean ± SD systolic right ventricular to right arterial pressure gradient (24.3 ± 5.9 vs. 24.7 ± 4.9 mmHg) and exhaled NO (19.2 ± 7.2 vs. 22.5 ± 9.5 ppb) were similar in Bolivians and Caucasians. There was no relationship between ,pulmonary-artery pressure and respiratory NO in the two groups. These findings provide no evidence that Bolivian high altitude natives are better protected from hypoxic pulmonary hypertension than Caucasian low altitude natives and suggest that attenuation of pulmonary hypertension by increased respiratory NO synthesis may not represent a universal adaptation pattern in highaltitude populations.

High-altitude exposure in patients with cardiovascular disease: risk assessment and practical recommendations.

Because of the development of modern transportation facilities, an ever rising number of individuals including many patients with preexisting diseases visit high-altitude locations (>2500 m). High-altitude exposure triggers a series of physiologic responses intended to maintain an adequate tissue oxygenation. Even in normal subjects, there is enormous interindividual variability in these responses that may be further amplified by environmental factors such as cold temperature, low humidity, exercise, and stress. These adaptive mechanisms, although generally tolerated by most healthy subjects, may induce major problems in patients with preexisting cardiovascular diseases in which the functional reserves are already limited. Preexposure assessment of patients helps to minimize risk and detect contraindications to high-altitude exposure. Moreover, the great variability and nonpredictability of the adaptive response should encourage physicians counseling such patients to adapt a cautionary approach. Here, we will briefly review how high-altitude adjustments may interfere with and aggravate/decompensate preexisting cardiovascular diseases. Moreover, we will provide practical recommendations on how to investigate and counsel patients with cardiovascular disease desiring to travel to high-altitude locations.